A study by the UJI and the Fisabio Foundation demystifies the dangers of water birth

Women who use water immersion during labour and birth experience better maternal and neonatal outcomes compared to those who receive epidural anesthesia, according to a study led by midwife Soledad Carreguí, in collaboration with researchers from the La Plana Health Department (Castelló) and the Departments of Computer Languages and Systems and Nursing at the Universitat Jaume I.

The main findings indicate that water immersion is associated with a higher likelihood of spontaneous vaginal birth, a lower probability of vacuum-assisted delivery, and shorter dilation and expulsion times. For newborns, water use —compared with epidural analgesia—was linked to a reduced need for respiratory support and fewer neonatal admissions. A higher rate of exclusive breastfeeding at discharge was also observed, particularly among first-time mothers.

Regarding mothers, the study found a lower need for obstetric interventions during labour, such as oxytocin stimulation, bladder catheterization, or fetal scalp pH sampling due to fetal heart rate abnormalities. The results suggest that water immersion supports the physiology of childbirth and is a valid, safe option that helps women experience a more respectful birth while reducing the need for medical interventions that may carry adverse effects.

In recent years, there has been growing social and scientific concern about promoting more physiological births and avoiding, whenever possible, excessive interventions and medicalization. According to data from the Spanish Ministry of Health, all hospitals currently offer epidural analgesia —the most effective method for pain relief during labour— and 61.97% of women choose this option. In Spain, however, only 16.5% of hospitals in the National Health System have birthing pools, and just 5% allow birth to take place in water.

The research team hopes that “this study will help support and promote the installation of birthing pools in other hospitals, thus offering the option of using water during both dilation and birth”. The authors describe water immersion as a safe and effective resource that should be available to all women with low-risk pregnancies as a non-pharmacological method to relieve pain and support mothers during labour, improving care quality and promoting the health of both mothers and newborns.

The project has also helped to unify working standards for hydrotherapy during labour and birth, ensuring safety and rigour throughout the process. One of its main strengths is that it was conducted in a single hospital with a standardised water birth protocol, guaranteeing consistency in the results.

The IT system developed by Ricardo Chalmeta, Professor of Computer Languages and Systems, and Carregui incorporates an interface via a web portal and a mobile application. This allows mothers and healthcare professionals to include additional variables related to a satisfaction questionnaire. This tool facilitates data exportation for processing through Excel or statistical software such as SPSS, and is registered as an invention by the Research Management and Transfer Service.

The research team, which expressed its gratitude to all the women, babies, midwives and staff involved, believes that the findings also foster women’s autonomy and informed decision-making. They add that this practice “could help reduce unnecessary interventions, maternal and neonatal morbidity and mortality, and the associated social and healthcare costs”.

The study was conducted at La Plana University Hospital, a leading centre for low-intervention, normal births with strong maternal and neonatal outcomes. The hospital handles around 1,300 births per year and offers women two of the most requested options: epidural analgesia and water immersion, both for dilation and birth.

In total, data from 603 women were analysed between June 2020 and February 2023: 284 used epidural analgesia and 319 used water immersion (82.4% of the babies were born in the water). The participants’ average age was 31.8 years, 44.6% already had children, and 47.4% held university degrees —a higher proportion among those who chose water immersion.

The project was funded by the Universitat Jaume I and the Foundation for the Promotion of Health and Biomedical Research of the Valencian Community (Fisabio) through grants UJI-B2022-15 and UJISABIO-2019-19I612. The findings were published in the article "Epidural or water immersion? A prospective cohort study of maternal and neonatal outcomes in a tertiary hospital" in the journal Midwifery, and Soledad Carreguí earned her doctoral degree with the thesis "Entre la inmersión en agua y la analgesia epidural: efectividad, seguridad y experiencia del nacimiento" (Between water immersion and epidural analgesia: effectiveness, safety, and birth experience).